Is It Rhabdo Or Muscle Soreness? How You Can Tell The Difference

As the guy whose been almost single-handedly educating the American public about rhabdomyolysis (rhabdo) for over a decade – AND the author of the first book ever written on rhabdo and exercise – it's safe to say, I get a lot of questions about this medical condition. But no question is more common than “Do I have rhabdo or is it muscle soreness?” This makes sense because both rhabdo and Delayed Muscle Soreness (DOMS) have some things in common. If you've been searching for whether you have DOMS or rhabdo, you have come to the right place. I'm going to answer that question now.

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What Is DOMS?

Delayed Onset Muscle Soreness (DOMS) is the feeling of pain and discomfort we've all felt at one time or another. Delayed muscle soreness usually shows up a day or two after exercise or other physical activity and it's especially common with activities that are harder /more intense than usual or activities we have not done before or not done in a long time.

While the exact cause of DOMS is a mystery, much of the pain is the result of eccentric muscle actions (“negatives“) which occur as the muscle is lengthened. An example, of this, is lowering a dumbbell during a biceps curl.

While DOMS may hurt – and hurt a lot – it is not serious and should start to feel better after 3-4 days. Muscle soreness should be mostly better after about 5 days.

What Is Rhabdo?

Rhabdomyolysis -like regular muscle soreness (DOMS)- also occurs after performing lots of unfamiliar activities. This can be workout-related or non-workout related activities such as household chores or gardening. Activities which cause rhabdo are also rhythmic in nature. In other words, activities where the same movement pattern occurs over and over again. For example, doing 10 sets of biceps curls or taking an indoor cycling class or painting a room.

Also like DOMS, rhabdo has a connection to eccentric muscle actions too (negatives). All that said, there are some differences between rhabdo and muscle soreness and these differences can help you tell them apart.

Rhabdo vs. DOMS: The Differences

While both rhabdomyolysis and DOMS share things in common, there are some key differences that most overlook. They are:

The pain starts to hurt quicker than DOMS

Rhabdo pain hurts when you are not moving

Let's address each of these in more detail next.

Video: The Difference Between Rhabdo And DOMS

Here's a quick video I created to help you tell the difference between rhabdo and muscle soreness

Rhabdo Pain Occurs Quicker

While delayed muscle soreness (DOMS) usually occurs 24-48 hours after exercise, rhabdomyolysis pain can begin almost immediately after someone ceases the activity. Sometimes however the pain can take up to 24 hours before it kicks in.

The pain progressively gets worse as the hours' tick by. So, the pain may be much worse 8 hours later. This is why it's important to not wait before going to the hospital if you think you have rhabdomyolysis.

Over the years, I've received emails from people who waited until after 1 am before they decided to start researching what was causing their pain on the web. By that time, everyone else was asleep and they were embarrassed to call for help.

Please don't be that person.

Rhabdo Pain Hurts When You're Not Moving

My Rhabdo Book

For me, this is the key difference between rhabdo and DOMS. Regular, delayed muscle soreness, does not hurt when you remain stationary. You only feel pain when you move or press on the area. The muscle pain from rhabdomyolysis hurts even when you are not moving.

So if you're reading these words and think you have rhabdo, sit where you are and don’t move. Do you feel pain now? If no, it's probably DOMS. If you do feel pain, it may be something else.

Obviously, this simple test does not tell us if something else is going on like a strain or sprain. But, if you remember, that pain and discomfort felt when you are not moving is a sign of something other than DOMS, this arms you with more information that can help you make a choice whether or not it's muscle soreness or not.

What About Dark Urine Color?

Many people these days discuss how rhabdomyolysis is accompanied by a change in the color of the urine. The urine is darker than normal and described as looking like ice tea or cola-colored (think Pepsi or Doctor Pepper or Coke-a-Cola). While this is often true, do not use urine color change as a visual sign of rhabdo. This is because many people with the disorder have normal-looking urine.

The pee test doesn't always work. So, you can still have rhabdomyolysis even if your urine appears normal looking.

Do I have Rhabdo?

OK, lets sum this up. If I were with you right now and you told me you through you had rhabdomyolysis, these would be the questions I'd ask you:

1 Did you recently do an exercise or activity (workout, gardening, painting the house, etc.) you had not done before or done in a long time?

2 Do your muscles hurt when you are NOT moving?

If the answer is yes to those 2 questions, I'd suspect you might have rhabdo. At that point, I might also ask you how your pee looked but even if you told me your urine looked yellow or looked normal, I might still suspect it from too much exercise/ activity.

The fact you are having muscle pain when not moving isn't normal. I'd recommend someone take you to the ER and if nobody was available, call 911.

Why Do I Recommend Calling 911?

There are two reasons I suggest calling 911 if you think you have rhabdomyolysis:

1. Because by now you are probably freaking out over everything you've read on the internet about how bad this can be. Because you are not thinking normally, it's possible you might have a car accident as you raced to the hospital.

2. Rhabdomyolysis can be serious in some cases. Sometimes it can even impact how your heart works. I would not want you passing out while driving.

I'm admittedly a worst-case scenario kind-of-guy when it comes to stuff like this. I like to try to look down the road and try to minimize bad things happening before they occur. This is why I'm suggesting having someone drive you to the hospital or calling 911.

Will I Be Ok After Rhabdo?

Rhabdomyolysis is a serious condition and yes, some have died from its complications – but most don't, so that's good. While many people may recover from rhabdo on their own, you can't know how bad you have it until you get medical attention. While the odds are good you will recover, remember this is your body – the only body you will have. You exercise to keep it healthy. In cases of over-exertion, think of getting medical attention as another way you are keeping your body in tip-top working condition.

I really hope this helps.

Do You Have Any Questions?

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Comments

Jim,
I recently got rhabdo from working out and spent four days in the hospital. My urine color was never the slightest bit dark or any different than what it normally looks like. There was no abdominal pain as you state there would be either. Had i not gone to the hospital, my kidneys may have been permanently damaged, so it’s not something to be taken lightly.

Since then, I’ve had many conversations with people in the fitness world and am finding rhabdo may not be as rare as some believe it is and many times it just goes undiagnosed. The information Joe Cannon provides on his site was incredibly helpful to me and he does know what he’s talking about.

Amy thanks for taking the time to reach out to Jim. For everyone reading this Amy’s interview whcih details how she got rhabdomyolysis will be posted on this site later today. I’ll circle back and link to it here so you can read it.

This video is complete bullshit and this guy is a complete moron. If your are sore after a workout not moving this is not rhabdo!!! Rhabdo is extremely rare and you would need to really work the muscle out to the point you can almost not contract the muscle. Extreme stiffness and pain after And if you have rhabdo your pee will not look normal at all! It will be tea colored and most likely serious abdominal pain.

Please dont go running to the hospital cause your sore being idle after a workout, dont waste your time or money. And again rhabdo is extremely rare . Do drink water throught the day filter out the myoglobin. But youll be fine im sure its not rhabdo.

Jim, Don’t attack who you don’t agree with. That said, you bring up some interesting points that I want to correct that should help others:

1. Rhabdo CAN happen even after exercise/activity that is NOT “extreme.” I’ve met those people. Some have gotten it from gardening and painting a room. It’s not just extreme / intense exercise that can cause rhabdo. There’s no debate on this fact.

2. DOMS hurts when you are not moving. Pain felt at rest is not normal. This is why I used pain at rest as a possible sign of rhabdo. It could also mean something else but if you feel pain when you are not moving, it’s a quick way to tell that its NOT just muscle soreness. It’s something atypical. Since most people cant differentiate between DOMS and rhabdo, this is a quick assessment tool. While this is not fool proof-I’ve encountered people who were not sore but still had rhabdo. Generally, people tend to report to me they are sore when they are not moving.

3. Rhabdo is probably very rare. Most people will not get it. But, rare or not, that’s little consolation to those in the hospital with rhabdo. I’ve get their emails and seen their social media posts almost daily. I cant say how rare it is because I have not seen any recent statistics for the general population. Some studies mention a statistic of about 26,000 cases per year but that stat seems to date to the 1990s.

4. Rhabdo does NOT ONLY impact the kidney. You are 100% wrong about this. It can cause heart attacks and liver failure. It can increase swelling in the limbs that may require surgery fix. Drinking water will NOT solve the these other issues. Water does not stop muscle fiber death, which is what rhabdo is.

In theory, drinking too much water could induce hyponatremia, which can be just as serious as rhabdo.

5. Not everybody with rhabdo gets dark colored looking urine. This is a common rhabdo myth.

Rhabdo is getting a lot of attention by the news-media these days. While I dont want a rhabdo-hysteria to occur, I also dont want people to suffer in silence. The safest course of action is to get checked out by a physician and not listening to anyone online whether it be you or me.

Desiree, there are different kinds of massage. There is at least 1 report of massage causing rhabdo. I do think the odds depend on the kind of massage someone has (deep tissue vs Reiki for example). That said if you have rhabdo, I would not recommend massage. Massage causes muscle damage and this could compound the muscle damage you already have with rhabdo. In the past, some who had rhabdo -and got a massage -told me it made things worse.

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Credentials

Joe Cannon, MS has written for several publications including The Journal of Strength and Conditioning, Today's Dietitian, and Prevention. He's been quoted in the New York Times, lectured to NASA and has been a content consultant for Dateline NBC. He's the author of the first book ever published on rhabdomyolysis and exercise.
Joe Cannon, has a BS in Chemistry and Biology and a MS in Exercise Science. He is a Certified Strength and Conditioning Specialist (CSCS) and a personal trainer certified by the National Strength and Conditioning Association (NSCA).